By Paul Kane, Ben Pershing and Perry Bacon Jr.
Washington Post Staff Writers
Tuesday, September 8, 2009
After a nearly 40-day recess that was anything but restful, House Democrats are returning to work Tuesday still unsettled over pending health-care legislation and sure only that the people have had their say.
They are in almost the exact position they were in when they left the Capitol in late July. Conservatives are still leery of supporting a government-funded, or public, insurance option. Freshman lawmakers from suburban districts remain fearful of increasing taxes for their wealthy constituents to pay for the new measure and await alternatives from moderate Senate Democrats. And progressives, who are demanding the most far-reaching reform since the Great Depression, are still threatening to bring down the legislation if it does not contain a robust version of the public option.
In the lead-up to President Obama's critical Wednesday night address to a joint session of Congress, interviews with a cross section of about 15 House Democrats and half a dozen aides show that there is still overwhelming support for some overhaul of the health-care system. But the caucus remains deeply divided over the details of the more than 1,000-page measure and now faces a public that is more skeptical than when House committees began drafting the plan two months ago.
"We knew a lot of work still needed to be done, so no, not a lot has changed," said Rep. Stephanie Herseth Sandlin (S.D.), a leader of the Blue Dog Coalition, a group of 52 Democrats from moderate-to-conservative districts.
House Democrats are the canaries in the coal mine for Obama's most important domestic policy issue. As originally planned, the House was already to have passed its health-care legislation, with a far-reaching public option for insurance, based on Democratic votes, as Republicans have lined up in almost unanimous opposition to the House version. Despite their large majority, Democrats faced internal opposition in late July and agreed to delay the vote until late September at the behest of dozens of Blue Dogs and other Democrats worried about the public's view of the legislation.
House Democrats are still expected to take the first step on the legislation, assuming that the frenzy of early August -- with the continual image on cable news of Democrats at town hall meetings with angry voters opposed to the proposal -- has not solidified opposition within their own ranks.
Party leaders contend that the time spent at home gave the public unprecedented input on the legislation, allaying concerns of some Democrats who feared casting a vote before facing their constituents in August.
Democratic and Republican aides said the past 40 days brought an unparalleled level of public participation at forums, with some lawmakers reporting to their leaders that 1,000 people showed up at events last month, compared with the 30 people who attended town hall meetings in the same location during previous August breaks. By late last week, House Democrats said that since Aug. 1, their members had held 1,029 public forums, teleconferences with constituents or health-care gatherings in their districts.
"I think this month can be viewed as participatory democracy, members going out and talking to the people," said House Majority Leader Steny H. Hoyer (D-Md.). "Nobody can say we haven't taken the time to look" at the legislation.
But House Republicans, who held hundreds of their own town hall meetings that drew more than 100,000 voters, according to preliminary estimates, viewed the break as a galvanizing moment for opposition to the Democratic legislation. "I heard people saying, 'Look, we need health-care reform. We need to do something to lower the cost of health insurance for families and small businesses and lower the cost of health care,' " said Rep. Mike Pence (Ind.), the third-ranking GOP leader. "But I also heard people say that they don't want a government-run plan that is going to lead to a government takeover of health care."
Clearly, the recess did not go as scripted for House Democrats.
As the 5 1/2 -week break began July 31, Democrats handed out seven-inch-long pocket cards for their members to carry like political shields. The cards listed popular parts of the legislation to be emphasized at town hall meetings, including banning insurance companies from denying coverage to people with preexisting conditions and prohibiting them from dropping or declining to renew coverage for people who become sick.
Instead, according to rank-and-file members from all corners of the caucus, lawmakers spent most of August rebutting misleading claims, such as the myth that the legislation would create federal "death panels" for elderly patients.
"A lot of what they've heard and they don't like isn't really in the bill," said Rep. Brad Miller (D-N.C.), who supports the legislation. "President Obama needs to start talking about what's in the bill, not what's not in the bill. Whenever I see him on TV, he's talking about what's not in the bill."
The popular parts of the measure mask a deep-seated ideological conflict within the 256-member House Democratic caucus. Eventually, Hoyer and House Speaker Nancy Pelosi (D-Calif.) will have to begin choosing sides on the final makeup of the legislation, which is being compiled from the work of three committees. Each concession to one bloc of the caucus threatens to create opposition from another.
Pelosi continues to voice support for a public insurance plan, suggesting that she cannot pass a bill that does not include it. This has put her at odds with some Obama advisers, who are signaling that they are willing to do without a public option if the House and Senate can approve other major pieces of the legislation.
But liberals, whose ranks dominate the House caucus, view a public insurance plan as the linchpin of the entire effort because, they say, it fosters competition with private insurers, driving down the cost of premiums and other services.
"Health-care reform without a good public option is not health-care reform at all," said Rep. Lynn Woolsey (Calif.), a leader among House liberals. "We have to do this. That's why we're in the majority. That's why we have the White House."
Woolsey and more than 60 House Democrats sent Pelosi a letter last month vowing to vote against any reform measure that does not include a strong public option. That is more than enough Democrats to torpedo reform if Obama accepts a centrist approach.
But the latest version of the public plan in the House legislation -- the product of a late July compromise brokered by Pelosi, White House Chief of Staff Rahm Emanuel and a quartet of Blue Dog Democrats -- may be too expansive for dozens of other Democrats who want to see this plank delayed for several years or dropped altogether.
"I'm hoping we can find some middle ground," Herseth Sandlin said of the public option. "But if not, it should not be included."
Lawmakers from swing districts in the suburbs and rural regions went home to find constituents fearful of increased government involvement in the private economy. That view extends from the potential government option in health care to the bailout of the financial sector, the takeover of Detroit's carmakers and the $787 billion stimulus plan that many voters think has done little to stop job losses.
"Whether folks agree with it or not, the problem is there is so much skepticism of the elected officials, they don't believe us," said Rep. Frank M. Kratovil Jr. (D-Md.), who was narrowly elected last fall. Kratovil's recess began with a poster board image of him hanged in effigy outside his Eastern Shore office in a protest of the health-care plan. He said he remains undecided on the legislation.
Many Democrats do not want the House to act until they know what will happen in the Senate. That chamber has been stalled all summer as a bipartisan group of six senators on the Finance Committee has tried to reach a compromise that does not include a public option, costs much less than the $1.2 trillion House version and does not include a surtax on the wealthy.
If the Senate bill does not include a public option, many House Democrats will not want to vote for it in their version, because it would be unlikely to survive a House-Senate conference on the two measures.
The ultimate key to the legislation's fate in the House may rest with the roughly 80 lawmakers elected in the past three years, when the political tide was running strongly in Democrats' favor. Some come from rural districts and have joined the Blue Dog Coalition, but many are progressive in their approach to health-care reform, believing they were elected on a promise to offer change.
If enough of them can support the final legislation, leaders think they will be able to get a bill narrowly approved this fall and onto the president's desk before Christmas.
"I think, if anything, the mood has changed to be more favorable to health-care reform," said Rep. Mary Jo Kilroy (D-Ohio), who won her Columbus-based seat in 2008 by less than 1 percent of the vote.
"Personally, I'm probably more confident than when recess began," added Rep. Kathy Dahlkemper (D-Pa.), another freshman. She held 18 town hall meetings in her northwestern Pennsylvania district, which stretches from Pittsburgh's suburbs to Erie, and found that three-quarters of her constituents support some form of health-care overhaul.
"If I had just been listening to the media, I don't think I would have been as confident," she said.